Z2J-29803-66948

4 vaccinations 11 coded responses 27 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 721 / AR
Registered: 2021-11-01

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-04
Dose 1 — Moderna
2021-03-11
Dose 2 — Moderna
2021-11-01
Registered in v-safe
2021-11-01
Dose 3 — Moderna
2021-11-01
Health check-in — day 0, dose 3
Feeling: Fair · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-04
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Poor · Site: Pain, Redness · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: She has arthritis bad and short bowel syndrome, so sometimes her pain is hard to gauge. Also her birthdate year ia wrong on this and I don't know how to change it. I registered it with my phone number that I also did my covid vaccine through.

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Pelvic pain, Pre-existing disease, Urinary tract infection — Feeling: Poor · Fever · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: Don't know if it's short bowel syndrome, kidneys or something to do with shot. Taking Cipro for UTI but, have bad pelvic pain with BM that's not usual pain.

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-08
Health check-in — day 7, dose 3
Feeling: Fair · Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-15
Health check-in — day 14, dose 3
Feeling: Poor

Adult check-in
2021-11-22
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Survey response — day 28, dose 3
MedDRA: Diarrhoea, Influenza like illness, Pain, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Flu like symptoms, aches, vomiting, diarrhea. However, it could be medication related

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-13
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-31
Survey response — 3 months, dose 3
MedDRA: Hypoaesthesia, Pre-existing disease, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Having numbness in hands and arms but, I have bad disk. Don't think related to shot. 90 years old.

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Dose 4 — Moderna
2022-05-01
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Site: Redness, Swelling · Fever · Joint pains

Free text: Has arthritis and lots of pain anyway. So it's hard to say if it's related but, no more pain than usual.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Redness, Itching · Fever · None

Adult check-in
2022-05-03
Survey response — days 1–6 daily, dose 4
MedDRA: Hospitalisation — Feeling: Fair · Site: Redness

Free text: In hospital. Not related to vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — days 1–6 daily, dose 4
MedDRA: Arthritis, Fall, Pain, Rib fracture — Feeling: Poor · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Don't know if I have any symptoms from covid vaccine. Too much Arthritis and Pain due to fall and 3 fractured ribs.

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Survey response — days 1–6 daily, dose 4
MedDRA: Hospitalisation, Musculoskeletal chest pain, Rib fracture — Feeling: Poor · Be unable to do your normal daily activities

Free text: Pain in experiencing is from 3 fractured ribs. Just checked out of hospital today.

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Survey response — day 7, dose 4
MedDRA: Rib fracture — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fractured ribs

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Survey response — day 14, dose 4
MedDRA: Pyrexia, Rib fracture, Urinary tract infection — Feeling: Poor · Be unable to do your normal daily activities

Free text: UTI causing fever. 3 fractured ribs. 90 years old. Don't know if any of my symptoms are vaccine related or not.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-29
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-03
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-10
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-29
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-28
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-05-02
Survey response — 12 months, dose 4
MedDRA: Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-05-02
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna	No
2	2021-03-11	Moderna	No
3	2021-11-01	Moderna	No
4	2022-04-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-05-02	Unsuccessful

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-04

Systemic reaction (other): She has arthritis bad and short bowel syndrome, so sometimes her pain is hard to gauge. Also her birthdate year ia wrong on this and I don't know how to change it. I registered it with my phone number that I also did my covid vaccine through.

2021-11-06

Systemic reaction (other): Don't know if it's short bowel syndrome, kidneys or something to do with shot. Taking Cipro for UTI but, have bad pelvic pain with BM that's not usual pain.

Release 10 — day 28, dose 3

2021-11-29

Symptoms: Flu like symptoms, aches, vomiting, diarrhea. However, it could be medication related

Release 11 — 3 months, dose 3

2022-01-31

Symptoms: Having numbness in hands and arms but, I have bad disk. Don't think related to shot. 90 years old.

Release 11 — days 1–6 daily, dose 4

2022-05-01

Systemic reaction (other): Has arthritis and lots of pain anyway. So it's hard to say if it's related but, no more pain than usual.

2022-05-03

Systemic reaction (other): In hospital. Not related to vaccine.

2022-05-04

Systemic reaction (other): Don't know if I have any symptoms from covid vaccine. Too much Arthritis and Pain due to fall and 3 fractured ribs.

2022-05-05

Systemic reaction (other): Pain in experiencing is from 3 fractured ribs. Just checked out of hospital today.

Release 11 — day 7, dose 4

2022-05-06

Systemic reaction (other): Fractured ribs

Release 11 — day 14, dose 4

2022-05-13

Symptoms: UTI causing fever. 3 fractured ribs. 90 years old. Don't know if any of my symptoms are vaccine related or not.

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
SD	Diarrhoea	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rib fracture	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Urinary tract infection	·	·	✓
SD	Vomiting	·	·	✓
SRO	Arthritis	·	·	✓
SRO	Fall	·	·	✓
SRO	Hospitalisation	·	·	✓
SRO	Musculoskeletal chest pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Pelvic pain	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Rib fracture	·	·	✓
SRO	Urinary tract infection	·	·	✓

✓ active code · ○ coded but marked inactive · blank = not in that release